Treatment outcome

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Robert G. Badgett, M.D.[1]

In Quality of Health Care, Treatment outcome is defined as "Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series."

Statistical methods

Note that the standard error of measurement (SEM) is different than the standard error of the mean (SE):

• standard error of measurement (SEM) is "It is estimated by the standard deviation of the instrument multiplied by the square root of one minus its reliability coefficient". If they reliability coefficient is not know, 0.5 can be an approximation.
• standard error of the mean (SE) is standard deviation (SD) divided by the square root of the population size

Options for estimating the MCID:

• 0.5 change per item on Likert scales
• The minimal clinically important differences (MCID) has been proposed as >0.5 standard deviation improvement.
  • Copay et al used various methods to determine the optimal MCID.
    • Receiver-operating characteristic curve derived MCID: " The optimal cut-off value for a ROC curve corresponds to the point of optimal trade-off between sensitivity and specificity "
    • Half a standard deviation: Template:Sfrac \times {SD}
    • Standard error of measurement SD \times \sqrt{1 - r}, "where SD is the standard deviation of the baseline scores and r is the test-retest reliability coefficient"
    • Minimum detectable change: 1.96 \times \sqrt{2} \times{SEM}
    • Effect size derived MCID: "multiplying the SD of the baseline scores by 0.2 (the small effect size)"
• A 30% reduction in a score.
• A 50% reduction in a score.
• Responsiveness statistic of Guyatt is the mean change divided by the square root of 2 x mean square error
• The "response mean (difference of mean scores at 2 assessment points divided by standard deviation of score changes)...to compute the 95% confidence intervals of the standardized response means"
• One standard error of measurement (SEM) of Wyrich
• Jacobson has suggested:
  • "The level of functioning subsequent to therapy should fall outside the range of the dysfunctional population, where range is defined as extending to two standard deviations beyond (in the direction of functionality) the mean for that population."
  • "The level of functioning subsequent to therapy should fall within the range of the functional or normal population, where range is defined as within two standard deviations of the mean of that population."
  • "The level of functioning subsequent to therapy places that client closer to the mean of the functional population than it does to the mean of the dysfunctional population."

See also

• Attention-deficit hyperactivity disorder monitoring response to therapy
• Back pain monitoring response to therapy
• Statistics